September 28, 2012

After participating in the low carb call-in show and hearing from so many dieters there and in the email the show provoked, I started thinking it might be interesting to do a stint of very low carb dieting myself, just to see if I noticed anything new, now that I've done so much research.

Though I ate a very strict low carb diet for many years, I have been eating under 110 grams a day since 2009, largely because the medication choices I'd made have made it possible to keep my blood sugars in better control at that level than at a lower one.

The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.

That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help. But once I was healed up, I decided there was no real point in eating a ketogenic diet since my main focus is on blood sugar control

Things are quite different now. My blood sugar is better than it has ever been, thanks to my very unusual response to a low dose of Coenzyme Q10. (I am currently exploring what might explain this and have called on an expert in oddball forms of diabetes to help me with this. I'll report on it if I learn anything that will be useful to others with odd forms of insulin-sensitive diabetes.)

But because I've been able to eat much more widely than I had been able to, even with insulin, I have been eating a lot these past few months, and though my scale weight was only up 2-3 lbs, my pants informed me that I had a choice: cut back a bit, or buy new pants. That's the kind of message I take seriously, so this past Monday I embarked on a new very low carb diet.

What Was Different This Time?
One thing that was different this time is that the work I did last year to upgrade my nutritional calculator using the most up-to-date formulas and taking into account body fat percentage yielded me more information about what it would take for me to lose weight. That meant that unless I wanted to diet for the next 6 months, losing the 3 real pounds I'd set as a weight goal meant cutting way back on calories to a level that ruled out any "luxuriant eating."

I decided to see what would happen if during the first week I ate following the guidelines that the calculator set for losing 1 lb a week. I used my bodyfat percentage as estimated by my Tanita scale, which gave me a slightly higher caloric intake than the calculator gives me when I omite body weight percentage. (That's because I truly do have a "large build" with very big leg muscles for a women--so big that even when I weighed 110 lbs I couldn't fit into those fashionable Frye Boots that everyone wore in the 1970s.)

The calculator told me that I could lose a pound a week eating roughly 1050 calories a day.

How Much Protein To Eat?

This posed one problem--was I to calculate how much protein I should eat based on the formula used for experienced low carbers, or should I use the formula for beginners that assumes that I would need a lot of extra protein to provide glucose to run my brain until it switched over to burning ketones?

At this low a calorie level, eating the extra protein would make it impossible to eat a safe low carb diet, because protein would use up all my calories leaving my fat intake dangerously low.

I decided to experiment and see if my body remembered how to burn ketones after my 7+ years of low carbing in the past and stick with a protein intake that while higher than my requirements while in a fully ketotic state was a lot lower than the amount needed for a newbie.

That seems to have been a good call. I'm on Day 5 and have been in Ketosis every time I have tested since Day 3 (based on testing with urine testing strips) except once after I ate some protein powder that seems to have had more carbs in it than the label claimed.

I haven't had any headache or other symptoms that come from adjusting to burning ketones. So apparently there is no need to eat any more than the amount of protein a long-term low carber would need.

How Much Glycogen-Associated and Water Weight Loss?

I lost 3.5 lbs within 24 hours of starting my diet. This suggests that much of my most recent weight gain was water weight, possibly from eating too much salty food. That is too short a time for me to have burned through three pounds worth of stored glycogen.

Since I have been taking metformin for years, I probably don't have a lot of stored glycogen left to burn. My experience in the past while low carbing while taking metformin is that I don't lose glycogen-related water weight. However, if I stop taking metformin, I regain what looks a lot like glycogen-related weight for the next week.

How Much Real Weight Loss?
After that first day's loss, I haven't lost any more weight. I weighed the same this morning as I did Tuesday morning. However, I don't really expect to see real weight loss occuring that quickly, since even if I am eating at a level that will result in a pound of real weight loss over a week after 4 days I would have only lost slightly more than .5 lbs, which is an amount easily hidden by salt-related fluctuations.

How's My Blood Sugar Reacting?

My fasting blood sugar was 91 mg/dl the morning before I started my diet. It dropped to 85 the next day and was 84 any time I tested it until this morning when I woke up at 76. An hour after lunch today it was again 76.

When I felt hungry, I used my 2 gram cure and it worked. I used it five times over the past 4 days, but never more than once within a 3 hour period.

What is the Impact on My Blood Pressure?
My blood pressure had risen the past two weeks, as it always does when the house chills down (I refuse to run the heat until October, but having adapted to 73 F all summer the mornings we experience that are 64-65 F takes some getting used to.)

My blood pressure dropped remained high on Day 1 and 2, then dropped quite dramatically, to normal on Day 3 and morning on Day 4. Then in the afternoon of Day 4 it shot up very high (163/89) after I experienced a burst of stress hormones. It was normal again on the morning of Day 5 (123/76).

I think the stress hormones were the result of either blood sugar or blood pressure dropping too low, generating a counterregulatory burst.

In the past when I ate LC I had several dramatic stints of very high blood pressure, contrary to what you read in the bestselling books. I will keep a closer watch on both sugars and BP to avoid the stress release as it feels rotten and takes 3 hours to abate.

What Am I Eating?
Not much! 1050 calories is such a low calorie intake that it's tricky getting enough protein without going overboard on the fat. All the usual low carb diet tricks that make low carbing enjoyable and sustainable are out. Bacon and cream cheese have too much fat for the protein they contribute. So I am pretty much testing Stephen Guyenet's theory that eating boring food helps us lose weight.

I'm using my food scale to weigh everything, and learning how fast those calories pile up. I'm also seeing how many of my "go to" low carb foods that I eat when I'm not trying to lose weight push my calorie intake way up--like the low carb cocoa I make with half and half or the bits of cheese I put in my salads.

That said, since with the exception of my experiment with the protein powder my blood sugars have been rock solid flat, I haven't been hungry except, sometimes, an hour or so after eating and about 9 P. After eating is when I've used the 2 gram cure. I'm thinking I probably ought to eat my last meal a bit later (I tend to eat dinner between 5:30 and 6 PM.) That might keep me from getting hungry right before I'm ready for sleep.

decaf coffee 2 cups a day. I'm not avoiding caffeine for diet reasons, but caffeinated coffee
pushes up my blood pressure so I am not currently drinking it.

NOTE: The Six Star brand Vanilla Cream Protein Powder I bought at Walmart tasted revolting and raised my blood sugar. It took 20 minutes for the aftertaste to go away.
Highly NOT recommended.Nutritional Breakdown
LifeForm tells me that my average daily intake for 5 days (including tonight's dinner) has been 1045 calories.

Fat: 63 g, 58%
Sat fat: 28 g, 26%

Carbs: 22 g
Fiber: 3 g (I am also taking a spoonful of no-sugar psyillium ever day)
Sugars: 14 g (this includes the sugar in the yogurt which I believe has been fermented
away)

Protein: 81 g 34% (My requirement to supply my brain after adapting to ketosis is only 63 g but I wanted some slack to avoid consuming muscle if I was wrong about the
retained ability to adapt.)

I'm not sure if this is interesting to anyone but me, so let me know if you want to hear more in the comments, where I'll also be happy to answer questions.

48
comments:

Very interesting Jenny, p;ease continue to share. I don't understand it all as I am a newbie but it really helps to hear and makes me hopeful that bit by bit I will learn what I need to know. I am type 2 and trying to find my way through low carb living with little to no support. I just bought Diet 101 and working my way through it. Thanks for everything!

I found this article very interesting. I wish you well. Your blog and website have been enormously helpful to me.

I have been low-carbing for almost 2 years, (40 to 50 gm/day) and my last 3 A1Cs have all been 5.0. Lately I asked my M.D. to prescribe metformin so that I could be more liberal with my diet and to my great disappointment there has been no change in my blood glucoses, even taking 2000mg two times a day of metformin fro the past 3 months and with no change in diet. So my interest was piqued when you mentioned Coenzyme Q10. I plan to google it as soon as I finish this response to your blog. If you have any info about it as it relates to DM2 I'd be very interested. Thanks for sharing your vast knowledge with us. Jim

Prostat 64 is a good option to raise protein if you are trying to follow a very low cal diet of ~1000 or so. 2 tablespoons = 64 calories and 15 grams of protein. You can take this and still have room to eat "enjoyable" things that make sticking to diet easier, and the good thing about prostat is the protein is very useful for preserving muscle mass due to the bias of amino acid. The advantage of this to whey protein is whey protein contains fat calories which increase the cal/protein ratio and whey is an ordeal to take whereas prostat you just drink like a shot and you're done.

I maintain around ~1700 or 1800 and I don't eat 3 meals per day, I tend to have a few snacks/nosh frequently early in the day and then pig out a few hrs before bed. My cals will be like ~600 or so before the few hrs I go to sleep. I find this works better for controlling sugar and appetite and increasing emotional satisfaction.

There is very little evidence about the impact of CoQ10 on diabetes. One study that found it lowered blood sugar and one that it didn't.

It is known to help people with MIDD a rare form of diabetes which is inherited from the mother and causes deafness and muscle weakness. I definitely don't have that.

I am currently awaiting some info from someone who may be able to help explain this.

I assume it has to do with helping out the mitochondria. The kind of MODY I suspect I have involves dysfunctional mitochondria in the beta cell.

It's worth a try, but I haven't heard from other people who get my kind of results from it. If you try it, try a low dose (50 mg) not a large one. Antioxidants can have a paradoxical effect on mitochondria.

Thanks for this Jenny. I appreciate your careful record-keeping! Will watch with interest. Your Blood Sugar 101 book was very helpful to me. Dropped my A1C from 6.5 to 5.58 in only 3 months, by staying at 60 carbs a day.

Mostly I just use protein powder to make pancakes with (along with eggs). I don't usually do shakes. But it's a long drive to the mall that sells the Precision Engineered brand that cooks decently, so I figured I'd test the Walmart one. UGH!

I maintain at about 1600 calories usually. It works best for me if I have about 200 calories for breakfast and a decent lunch and dinner, whichever one is biggest depends on which meal I eat out or socialize at.

Please be careful if you are a type 1 diabetic. When you start to make a decent level of keytones your insulin requirements will drop dramatically and almost instantly. Make sure you are wearing a sensor that is well calibrated and test your blood more often until you are used to being in ketosis.

I really enjoyed your latest interview with Jimmy. On one hand it wasn't what I wanted to hear but it was honest and reflected the common (but maybe not often reported) experiences of many women on a low-carb diet.

That's what this whey protein powder was supposed to be. But I find it very difficult to believe that anything that tasted that artificial and chemical could possibly be good for me.

There is so much hype and downright lying in the supplement and nutritional product department that I have very little faith in most of it. Mostly I just like protein powder as it replaces wheat in quite a few kinds of foods (pancakes, muffins, etc.) and makes a satisfying snack that can keep me from being hungry for quite a while.

Jenny, I am finding this quite interesting and timely. I've been low carbing for 5 years. It works great to keep my blood sugar below 5.5 A1C, but in the past year my weight has been creeping up. I did 900 calories a day, 25g carb, very well monitored, for 2 months and didn't lose a pound. How is that even possible? It's danged depressing. I feel like if I can't get a handle on this I'm going to gain back every pound I ever lost.

Please be careful to have a full thyroid profile done that includes Free T4 and Free T3 prior to going vlc and during the dietary change. My daughter-in-law, who is a Type 1, was vlc for several years and ended up very low Free T3 and Hashimotos Disease. She has had to increase her carb intake and is taking medication for her condition. ( Cytomel and Synthroid).

I wish I knew WHY it happens, but I don't, though I certainly know that it DOES happen.

Chances are that you won't regain all you lost unless your original weight was pretty close to where you are now. Most people who restrict carbs seem to be able to maintain 20% of original weight lost if they lost a lot, a bit less if they lost 20-30 lbs.

The real challenge is not to say, "To hell with it" and go off on a binge. That will put the weight back on.

Prolonged low carbing can do intersting things to T3, but it takes an autoimmune attack to cause Hashimoto's.

In any event, after three months on LC my energy level tanks, probably from the T3 issue, so I don't intend to stay on a VLCD for anywhere near that long.

I'm mostly just curious to see what happens if I put all my newly upgraded theories into practice, and whether it will make any dent at all in the old lady tummy fat that seems to be impervious to any intervention.

I exercised for a year and a half almost every day and saw no change in the tummy fat at all. My guess is that it might just be more of the fun associated with our so-called "golden years." Golden, I'm beginning to think, because of the gold we shell out to health providers as everything starts to fall apart!

I'm thinking I'll avoid the protein powder since the Greek yogurt contains so much protein in a palatable form.

I note that it raised my blood sugar only 15 mg/dl (from 74 to 90) which is what I'd expect 3 grams to do. Since the label states 8 g of carbs, I take it that the theory that the carbs are fermented away is mostly correct.

I'm avoiding any cooking for now because I'm testing Stephan Guyenet's palatability thesis.

It also struck me that I've unintentionally gone gluten-free, too. This is an absolute festival of diet theory testing.

I'm going to be very careful with what I change--putting my old debugger's hat on to see what, if anything makes a difference.

For those who *aren't* trying Stephan's boring-diet approach, it occurred to me that this "French toast" might taste better if you think of it as apple fritters instead of French toast. Texture is about the same.

One question about the nutrition calculator -- exercise level. I do weight training twice a week for an hour with a personal trainer (company pays for it, so yay!), plus two one-hour yoga classes (not just sitting around, it's sweaty and strenuous).

So, that's 4 moderate to heavy workouts a week (which have failed to do anything about the prominent Dunlop Disease, alas). The rest of the time I sit at a desk. So, does that average out to light exercise or heavy exercise?

The company also pays for an impressive variety of snacks, plus two catered lunches a week (can you tell I love my job?). I (do my very best to) stay out of the crackers, chips, etc., but I do partake of the lovely fresh raw California almonds (a handful a day), one or two small bags of peanuts, and a lot of the Kroger Carbmaster "yogurt" (60 cals, 1.5g fat, 4g carb, 8g protein).

I can see that I need to increase the protein and decrease the fat, so I'm afraid the peanuts and almonds will have to go. Protein powders are problematic -- chronic cold sores mean I have to watch the arginine and I supplement with 2g of Lysine daily which has had a noticeable effect on outbreaks and duration.

Latest HgA1c was 5.6, down from 6.1 the last time (doc says I'm pre-diabetic).

I would always advise erring on the side of underestimating the impact of exercise. Some of the research I discuss in my Diet 101 book suggests that women who exercise are LESS likely to maintain weight losses. Probably because they overestimate calories burned.

The longer the exercise the more your body adjusts and the less calories you burn, too. If you're wrong when you underestimate, you'll lose more weight than you wanted. (Yeah, right. Like that's going to happen!)

Ditch that Kroger yogurt and get one of those high protein Greek Yogurts with 18-20 grams and no added crap.

jenny, how can i get the most accurate use out of my glucose meter. i use the accuchek viva, and there is a 15 pt cushion. if i test twice, should i average the two readings? is the first reading usually more accurate? the second reading? the highest reading?? if i want to be as close to 85 as i can get, should i eat in a way that gives me lots of 70 some readings because if i add 15 points, that will be closer to 85?? the 15 point cushion is making me a little nutty!!!!!

My experience with Accu-chek meters was that they could be random number generators. A decent meter should match with itself withing 5 mg/dl pretty closely most of the time. The One Touch and the FreeStyle do that.

Do you have to use that meter? If you do I think you'll just have to accept some ambiguity. If you can test it when you go to the lab for a glucose draw that might give you some idea. When I took my Accuchek it tested 40 mg/dl higher than my actual reading (which was high--I was trying to show my doctor that I was indeed diabetic.) But when I was using it for insulin reading high meant I was hypoing when I thought I was okay.

FWIW, my Accuchek Aviva is more accurate than my OneTouch when I compare it to lab reports. It ran 10pts higher than OneTouch when I first started using it. The control solution can vary by 26% and they call it "accurate". I've been told that it's the strips that vary in quality and not necessarily the meter. Anyway, I like my Aviva.

I don't have to use that meter since i don't have an official diabetes diagnosis and so insurance isn't paying for anything or requiring me to get a certain meter. i care about accuracy so not only did i call dr. bernstein's office to ask what they are recommending, i also looked at the last consumer reports that dealt with glucose meters (nov 2011). accuchek viva was rated the best along with 3 others (i forget which ones) for accuracy, and dr. bernstein's office also recommended it. maybe i'll buy a new one.

I know Dr. Bernstein recommends the Aviva, but if you scan the discussion boards you'll find many other people who have had my experience with the Aviva. My first Aviva was recalled, so the company sent me strips and a new meter, and they were the ones that read so very off when I went to the lab.

I have two One Touchs (the plain old one and the mini) and when I've tested on the two meters they've matched each other closely and when I've taken them to the lab they have been close too. The Ultra I had was not as accurate, so I stopped using it.

Over the years most people have recommended the One Touch and my experience using it with insulin--where accuracy is really important--was that it was consistent except every now and then.

Bernstein is very rigid about what is normal blood sugar, but he basis his statements on readings he took of salesmen in the mid-1990s. Back then the meter calibration was different, so the 83 he claims is normal wouldn't be an 83 on today's meters. He seems unaware of that which makes me question his recommendation of meters.

This is seared into my mind because for years I was getting fasting readings on my meter when I ate low carb that were in the high 90s, which I thought was normal, but when the new meters came out all those high 90s turned into 108s and more.

That would be the number I would shoot for fasting and 2 or 3 hours after meal. But few truly normal person would maintain that reading an hour after eating a normal carb-containing meal.

It isn't necessary to be at 85 all the time to maintain health. It's staying high that damages organs and promotes beta cell destruction. Normal people drop back under 100 pretty fast, people with prediabetes stay over 140 for hours. That last is what you want to avoid.

I would personally aim to be under 100 at 2 hours if it was possible and under 140 at 1 if my goal was health. I hope I make this clear in my books.

I'm interested in the bit about LC helping healing after surgery. I'm going to have oral surgery in a few days, and already follow a LC diet. (I'm not diabetic, but I'm from a family full of diabetes.)

I was told in the past that I should eat extra protein to promote healing.The last time I had oral surgery I stayed low carb and higher protein and fat before and after. The surgeon said I was healing faster than he had expected.

"The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.

That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help..."

3 questions if I may:1. why do you think your fasting blood sugar went up if you were lower carb?2. why did you continue vlc for 5 months trying to improve blood sugars in preparation for surgery when your fasting blood sugars worsened on vlc? didn't you consider that since your fasting blood sugar was higher, that you may have had a higher reading throughout the night, in effect hurting your chances for a fast post-surgery recovery?3. did you have stress hormone bursts in the middle of the night waking you up?

But my post-meal numbers come way down, which is why I did it around the surgery. The fasting bg never went over 110 mg/dl so keeping the meals well under 130 mg/dl at all times was more important.

I healed up very quickly--so much so that it surprised my surgeon.

I did not have stress hormone bursts at night. The only time that happens to me is when I am taking certain blood pressure meds.

However, I don't have Type 2 diabetes. I have an oddball form of insulin sensitive diabetes that mostly imvolves a failure to secrete insulin at meal times. We are all different, and we all have to test different approaches to find the one that works for what is not working properly in our own, individual bodies.

also, have you ever seen dr. bernstein comment on why fbg might go up on vlc or about stress hormone bursts at night for people going vlc? my kind of genetic predisposition is also because of failure to secrete enough insulin. as you often mention, this seems to be a common reason for high bg. my mother started out on metformin and when it stopped working, was just like a type 1 having to take insulin at night and during the day. she also responded well to prandin. complications from breast cancer are what ended her life. god help the person with diabetes who has to undergo cancer treatment and see their blood sugars go through the roof with the treatment that is supposed to kill the cancer. i am trying to prevent that particular battle, which my mother fought for years at stage 4 before the cancer went to her brain.

During this period the explanation was that I wasn't using insulin or an insulin-stimulating drug to control my post-meal blood sugars when I was cutting carbs as doing so would have given me hypos. Using insulin at meals probably provided enough of a cushion that my body was able to make more insulin to cover the fasting state.

However, as I keep saying, it isn't the theory, or what happens in my own oddball metabolism, that matters what matters is what YOU observe about your blood sugar on the way to getting it under control.

Re your first post (which I saw second) I have written about the stress hormones HERE. It is a well known response, however, it is also one that can be extinguished by spending too much time at low blood sugars. And if it is, people using insulin can end up dead. This is one reason that some people with Type 1 don't follow Dr. Bernstein's approach, as losing that hypo awareness can be so dangerous and it can bee too easy for them to hypo while eating a very low carb diet if their insulin sensitivity fluctuates more than usual from day to day (as happens with brittle diabetes).

I'm so sorry to hear about your mom's very sad situation. If she responded to Prandin, she was probably not Type 1, as that response is a strong marker for HNF1A dysfunction (characteristic of MODY but also present in some other genetic forms of diabetes.) Prandin might also work well for you, but use very low doses and if you see your blood sugar drop into the 70s at any time stop taking it for a while. Otherwise, you can end up in the 40s or worse without warning and that isn't anything you want to have to go through. It happened to me and I have heard from several other people who experienced that who also had very good control with Prandin before the hypos.

However, if you are not eating carbs in your meals you shouldn't be experiencing true hypos--just the false hypos that are discussed HERE.

Re the cancer, I hope you are taking metformin as it does seem to have a protective effect against cancers in those who take it. That and keeping your blood sugar normal won't prevent cancers but it will slow them down as their favorite fuel appears to be glucose.

i hate to keep bothering you, but i don't know if i should take metformin. i am consistently getting 96-99 in the morning even though i often have readings in the 80s before sleep and in the middle of the night (if i wake up n take it). these readings are from eating low carb. if i ate the SAD i would be much higher- over 150 for sure.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.